Is back pain a symptom of prostate cancer?

Man holding his lower back in pain

Back pain is a common condition with numerous possible causes and explanations, from muscle strain to kidney infection. Prostate cancer is rarely one of them, but rarely isn’t never.

"Pain is rarely associated with early-stage prostate cancer," says urologist Bradley Webster, MD, of Roswell Park Comprehensive Cancer Center. In fact, there usually are no warning signs or symptoms of prostate cancer when the tumor is small. The disease can remain unknown for many years. This is why early detection tests are so important.

Back pain could be a symptom of advanced prostate cancer, however. “As the cancer progresses, back or bone pain can be a symptom, which is typically a sign of more advanced disease that may have spread to your bones. The spine, hips and ribs are the most common sites of spread,” he says. The pain can be variable but can feel like a dull ache in a single spot or pain that radiates from the bone.

“If the symptoms of back pain appear suddenly and without explanation or fail to improve with time, you should be evaluated by your doctor,” Dr. Webster says. “Bone fractures should also prompt evaluation for possible prostate cancer.”

Screening for prostate cancer — before any pain

About 1 in 8 men will be diagnosed with prostate cancer during his lifetime, and African American men face greater risk with 1 in 6 developing prostate cancer. Age is also a factor. It’s most frequently diagnosed in men over age 65, but rare in men younger than 40. Your family history, especially if you have a father or brother diagnosed with prostate cancer, also affects your risk for the disease.

Like most cancers, prostate cancer has far better outcomes when it is detected early. Routine screening, usually by your primary care doctor, includes a digital rectal exam plus a blood test to measure the amount of a protein called prostate specific antigen (PSA).

National guidelines from the National Comprehensive Cancer Network recommend PSA testing begin at age 40 for men at high risk — including African Americans, those with a family history of prostate cancer or who have a known genetic mutation associate with prostate cancer. Men at average risk should begin testing at age 45.

If your physical exam and PSA levels indicate a concern for possible prostate cancer, then you would be referred to a urologist for a possible prostate biopsy and to discuss next steps. For many men with early-stage, low-risk prostate cancer, active surveillance is an option, rather than starting immediate treatment. Also called “watchful waiting,” this approach includes routine monitoring of the cancer with magnetic resonance imaging (MRI), PSA tests and biopsy if needed, to detect if the cancer begins to grow. This allows men to postpone — and maybe avoid — side effects of treatment for a cancer that is unlikely to grow or cause any problems.

Symptoms to tell your doctor

“Prostate cancer is usually asymptomatic during its early stages which again highlights the importance of screening with your doctor,” says Dr. Webster.

Advanced prostate cancer can have several other symptoms in addition to bone pain, such as changes in how you are urinating or having bowel movements (more urgency, frequency, inability to defecate). “Blood in the urine, called hematuria, or blood in the semen, called hematospermia, may also be a sign of advanced prostate cancer,” Dr. Webster says. “Bone fractures may also result from the spread of prostate cancer to the bone.” “If you have changes in your urinary or bowel habits, blood in the urine or semen, bone pain or sudden changes in your ability to have erections you should discuss with your doctor. 

"Roswell Park Comprehensive Cancer Center has the word ‘comprehensive’ in its name for a reason,” Dr. Webster concludes. “Prostate cancer is treated in a multi-disciplinary fashion with urologists, medical oncologists, radiology, radiologic oncologists, geneticists and countless other teams working together under one roof to identify and treat prostate cancer at all stages of disease in a patient-specific fashion. We meet as a team to come up with a specific plan for each patient and treat each patient as an individual in order to obtain the best outcome.”